透明带薄化法激光辅助孵化对慢速冷冻和玻璃化冷冻卵裂期胚胎临床结局的影响

目的:探讨透明带薄化法激光辅助孵化技术对慢速冷冻和玻璃化冷冻卵裂期胚胎临床结局的影响。方法:回顾性分析复苏后至少有1个胚胎是完整存活的564例卵裂期冻融胚胎移植周期,根据胚胎移植前是否行激光辅助孵化,分为辅助孵化组(研究组)与非辅助孵化组(对照组),分别观察透明带薄化法激光辅助孵化技术对慢速冷冻胚胎及玻璃化冷冻胚胎的临床妊娠率、种植率及流产率的影响。结果:胚胎经慢速冷冻后,研究组胚胎种植率(19.5%)显著高于对照组(13.5%),差异有统计学意义(P<0.05),而临床妊娠率及流产率(37.9%vs 28.5%、15.5%vs 10.8%)无显著差异;胚胎经玻璃化冷冻后,研究组和对照组胚胎的临床妊娠率(38.0%vs 35.6%)、种植率(17.3%vs 15.9%)及流产率(7.6%vs 19.2%)相比较均无统计学差异;研究组中来源于2种冷冻方法的卵裂期胚胎的临床妊娠率(37.9%vs 38.0%)和种植率(19.5%vs 17.3%)无统计学差异(P>0.05)。结论:透明带薄化法激光辅助孵化能够提高慢速冷冻的卵裂期胚胎的种植能力,且不会增加其流产风险,但并不能提高玻璃化冷冻的卵裂期胚胎的种植能力。     

Blastocyst development of 4-cell mouse embryos after laser destruction of one blastomere with or without its microsurgical removal

AIM: To study the rate of blastocyst formation in 4-cell mouse embryos after laser destruction of one blastomere, with or without microsurgical removal of the destroyed blastomere. METHODS: Mouse embryos were randomly allocated to two control and two experimented groups. Control embryos were either non-manipulated (117 embryos) or underwent laser ablation of zona only (114 embryos). Experimented embryos had laser destruction of zona and the adjacent blastomeres. Destroyed blastomeres were either left in situ (115 embryos) or were microsurgically removed (107 embryos). They were cultured in sequential media for 72 h and were assessed for cleavage/morula arrest and blastocyst formation rates. RESULTS: Embryos arrested at cleavage/morula stages were higher when destroyed blastomeres remained in situ (30.4%) than when they were immediately removed (15.0%, P < 0.05). Blastocysts in the group with immediate removal of the destroyed blastomeres (85%) were significantly higher than when destroyed blastomeres were left in situ (69.6%, P < 0.05). Blastocyst formation in the repaired embryos was significantly lower than the non-manipulated (91.5%) and the manipulated controls (94.8%, P < 0.05). Hatching blastocysts were highest in control embryos with zonal ablation (72.8%). Proportions of hatching/hatched blastocysts in embryos, with or without removal of destroyed blastomeres, were not significantly different (39.3% and 33.9%, respectively). The percentage of embryonic loss during an attempt at microsurgical repair was 6.1%. CONCLUSION: Microsurgical removal of destroyed blastomere was effective in restoring blastocyst development. It could reduce the rate of cleavage/morula arrest.     

Laser-assisted hatching increases pregnancy and implantation rates in cryopreserved embryos that were allowed to cleave in vitro after thawing: a prospective randomized study

BACKGROUND: Cryopreservation of embryos may lead to zona hardening that may compromise in vivo hatching and implantation following thawing and transfer. Assisted hatching (AH) has been advocated as a means of assisting the natural hatching process and enhancing implantation. METHODS: The aim of this study was to assess in a prospective randomized manner the effect of laser-assisted hatching (LAH) on implantation as well as clinical and multiple pregnancy rates (the primary outcome) after the transfer of frozen-thawed embryos. All embryos were thawed the day before transfer, and LAH was performed the next day on embryos that cleaved. Control group consisted of embryos that were transferred without AH. RESULTS: The performance of LAH significantly increased implantation (9.9 versus 20.1%, P < 0.01), clinical pregnancy (27.3 versus 40.9, P < 0.05) and multiple pregnancy rates (16 versus 40.3%, P < 0.07). In the LAH group, significantly more excess embryos that were left in culture hatched in vitro. CONCLUSIONS: LAH improves the outcome of frozen-thawed embryo transfer when performed before transfer on embryos that were allowed to cleave.     

A randomized double-blind controlled study on the efficacy of laser zona pellucida thinning on live birth rates in cases of advanced female age

BACKGROUND: It is conceivable that defective embryo hatching plays a part in the mechanisms involved in the decrease of embryo implantation rates with advancing age. In an effort to test this hypothesis, we tested the effectiveness of assisted hatching (AH) in women > or =37 years of age. METHODS: We prospectively studied 103 IVF-embryo transfer patients undergoing 103 embryo transfers. All of them were > or =37 years of age and had <3 previous IVF-embryo transfer attempts. Laser-AH of transferred embryos was either performed (AH group, n = 49) or not (control group, n = 54) according to randomized and double-blind methodology. Primary outcome was live birth rate. RESULTS: Population characteristics were comparable in AH and control groups as well as the mean number of embryos transferred (2.7 +/- 0.6 versus 2.7 +/- 0.6) and the prevalence of top quality embryos transferred (65 versus 59%, respectively). We failed to find any statistically significant difference between AH and control groups with regard to implantation (16.1 versus 16.7%, respectively) and live birth rates (22.4 versus 29.6%, respectively). CONCLUSION: The present study indicates that AH does not improve IVF-embryo transfer outcome in women aged > or =37 years.     

激光辅助孵化对快速玻璃化冻融妊娠结局的影响

目的:探讨激光辅助孵化对移植玻璃化冻融胚胎妊娠结局的影响。方法:分析292个玻璃化冻融胚胎移植周期,其中激光辅助孵化组(171个周期)胚胎解冻后行激光辅助孵化,对照组(121个周期)胚胎解冻后不作辅助孵化,比较两组胚胎种植率和临床妊娠率,同时比较透明带削薄法与透明带打孔法对妊娠结局的影响。结果:激光辅助孵化组临床妊娠率32.35%,胚胎种植率20.70%;对照组临床妊娠率35.65%,胚胎种植率21.05%,两组间差异均无统计学意义(P>0.05)。透明带削薄法胚胎种植率及临床妊娠率均高于激光打孔法,差异有统计学意义(P<0.05)。结论:激光辅助孵化并不能提高玻璃化冻融周期的胚胎种植率和临床妊娠率,故不应常规对玻璃化冻融胚胎行激光辅助孵化;需要作激光辅助孵化时,应选择透明带削薄法。     

哺乳动物囊胚孵化调控机制的研究进展

哺乳动物囊胚在植入前,需从透明带中孵化出来才具有侵入子宫内膜的能力。囊胚孵化失败将引起女性不孕。囊胚孵化是一个受多因素精确调控的复杂过程,目前已发现的参与囊胚孵化的调控分子和信号通路,包括蛋白酶、环氧合酶-2、p38丝裂原活化蛋白激酶、激活素A和Wnt信号通路等。该文综述了有关因素对囊胚孵化的调控机制以及目前常用的囊胚辅助孵化的方法,为进一步阐明囊胚的孵化机制,为临床上对由于囊胚孵化失败引起女性不孕的治疗提供理论基础。     

左旋吡喹酮与吡喹酮治疗慢性日本血吸虫病对比观察

左旋吡喹酮与吡喹酮治疗血吸虫病患者189例和75例。均按30mg/kg的剂量,顿服,治后3个月与6个月粪孵阴转率分别为84.3%、86.5%与71.6%、72.9%;累积阴转率分别为73.5%与60.2%。二组的疗效比较有非常显著差异(p<0.01)。左旋吡喹酮组的无反应率(70.4%)与吡喹酮组(69.1％)比较则无差异(p>0.05)。该两药毒副反应均轻而短暂,无需特殊处理,自行缓解。治疗前与治后肝、肾功能,心电图和血、尿常规检查均无明显变化。临床研究结果证明左旋吡喹酮单剂疗法的疗效优于吡喹酮。我们认为左旋吡喹酮可用于血吸虫病流行区大规模普治     

准分子激光上皮瓣下角膜磨镶术矫治高度近视

目的 评价准分子激光上皮瓣下角膜磨镶术（LASEK）矫治高度近视的疗效。方法 选取高度近视患者27例（54眼）,术前近视等效球镜为-6.00～-14.00D,平均（-8.75±1.27）D。观察术后角膜上皮修复时间、术后视力、角膜上皮下雾状混浊（Haze）、角膜地形图及屈光度数,随访时间为6个月。结果 所有术眼术中及术后均无严重并发症发生。术后角膜上皮修复时间平均为（3.71±0.26）d。术后3d,裸眼视力≥0.5者48眼（88.9％）,≥0.8者19眼（35.2％）,术后7d,裸眼视力≥0.5者54眼（100.0％）,≥0.8者47眼（87.0％）,术后6个月,裸眼视力均达到或超过术前最佳矫正视力。术后1、3、6个月等效球镜均在-0.50～＋0.50D之间,术后1、3、6个月角膜Haze发生率分别为13眼（24.1%）、7眼（13.0%）、2眼（3.7%）,但均小于2级,不影响视力恢复。结论 LASEK治疗高度近视视力恢复好且稳定,无明显角膜上皮下雾状混浊及屈光回退。